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ELIZABETH A.NEVILLE ��'_e � Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 00 Pre+,i Southold, New York 11971
MARRIAGE OFFICER ,y Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ®1 �®iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,�� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2946 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ZOUMAS CONTRACTING CORP
Address 1: PO BOX 361
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-02-0200
Name Of Owner STATHEPOULOS, ANGLE
Mailing Address 1 38 LEE AVENUE
City St Zip YONKERS NY 10705
Property Address 1 580 THE CROSSWAY
City St Zip EAST MARION NY 11939
Tax Map No. section 30.00 block 2 lot 10.400
Cross Street THE CRESENT
Building Permit Number Cross Reference:
Issue Date: 12/26/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
oli OFFOUr 09 L&,
•
ELIZABETH A. NEVILLEy�; Town Hall, 53095 Main Road
-
TOWN CLERK o ; P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS ; ® Fax(631) 765-6145
RIAGE.OFFICER
RECORD }AVIANNGFiMENT OFFICER s- T �l $b i" Telephone (631) 765-1800
FREEDOM�OF INFORMATION OFFICER r��0 southoldtown.northfork.net
i'
± NO/ 19
2002 OFFICE OF THE TOWN CLERK
'T TOWN OF SOUTHOLD
TOWN . _,u .nip
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 19, 2002
Transmitted herewith is a copy of application No. 3066 for a Cesspool/Septic Tank Construction
Permit submitted by:
Zoumas for Archiles &Angie Stathopoulos
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: �f'
e2VSignature
///#1.0/A2—
Dated
/ a.0/4 2.
Dated
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OFFICE .•'' �� ou(e .z Application N6
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TOWN OF SOUTHOLD
a 1 Construction
^ P.O.BOX 1179 I 1'44-r 1,I, �,' ern = Alteration
SOU?i0!r, 1�z1YY0R�; 1!>i! t 1<i !� j to /
0i' �4''"W�O�•••• . $10. 00 - Residential
Telephones Non-Residential
.'- k � �` ,•• $25.00
(51 6) 765-1801 ,-rgil v
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
CONSTRUCTION or ALTERATION PERMIT '
SEPTIC TANK or CESSPOOL
Permit No,
Fee $
DATE 11 •# Q 1---- ,
•
APPLICANT NAME: OU AS_6gA-6- riG-C-GRI-1;
APPLICANT ADDRESS: Waciiitilive TNY 1-17-9-
-
SEPTIC r CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION .
j LI C P - i4
LOCATION MAP: Must be attached hereto before permit may be Issued.
LOCATION OF PROPOSED CONSTR CTION OR ALTERATION:' •
•
• OWNER OF PROPERTY : 41, I / D 1)/\-(3 2 -7-/9-7-4.01)0(11-i2-5
OWNER MAILING ADDRESS: ' . t GJO-JZ--
I, o' l
, . NY 1 .0-1a5 .
OWNER PROPERTY ADDRESS : (i_q C . 5 w
44 (V111-(\- 101`-'
TELEPHONE NUMBER OF CONTACT PERSON : /Q z5- gS
TAX MAP NO. : Section_ 3p _Block Lot,,_ Joy......- •
CROSS STREET : --1---,_(_(- C , (_,, ,_.42,,, ,/--r
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signa a 1. _ ilcan :a• • • e.;. . ,
RECEIVED B Y : �` ___g
. Town Clerk's Orrice''
DATE l( (F" (I �—_
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DWELLING — PUBLIC WATER LOT 18 LOT 17 - :-/-):4:1' ,:
VACANT 'DWEUJNG — PUBLIC WATER `••:�
NOTE:' LOCATION.OF',WATER'"MAINS • -1;`v` ( 0, "�
AND•ADJOINERS•WATER;;SUPPLY BY ' ,
OTHERS 'AND ARE':NOT:GUARAMIED. _ . ,• - • .
- TIC osis<pia,a 'a++drn;iII ''''FROM THE LICWI 3.10 THE ,
aaovamr USE-P10 Fl No. BEACH FARMS'
FOR�SPECIFIC: �� �"� 'JOB No. •02-424, RLE .
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uuun+ow�D ALTER ?l•os-Ao 1D:TWs Awe(Is:A NOu"-or taCflON ' LOT NUMBER 37 •
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CERTIFIEDONLY, T'0: ' - - EF•TAX' MAO, No.(RONLY),1000-30-2-104' . DISK 500
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